Non-Physician Practitioners in Nursing Facilities

Members can read more about nursing facility services here, and in Everyday Coding.

Question:

Can a physician assistant see patients in a nursing facility without a physician signing each encounter? How do we bill this? Can we do wellness visits in a nursing facility?

Answer:

• A physician assistant or an advanced practice registered nurse  may see patients independently in a nursing facility but must bill under their own provider number. Beginning 1-1-2022, visits that are not mandated as physician services may be reported as shared services between a physician and a non-physician practitioner.
• Mandated visits: Only a physician may bill the initial nursing facility visits 99304-99306 in a skilled nursing facility or nursing facility.  (There is an exception to this in a nursing facility when the practitioner is not employed by the facility). Sometimes, the PA/NP sees the patient at an earlier date than the physician, who comes and does the admission. In that case, the PA/NP bills a subsequent visit, even though the initial has not been billed. This is a Medicare rule.
• I am not aware of any restrictions against billing wellness visits in the nursing facility, provided it is appropriate to do a preventive plan for the patient. CMS is silent on this.

Here  is a link to the MedLearn matters article. It discusses frequency of mandated physician visits.

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